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CIIYOFT167ARD PEPWI—T NO . ME':'(3Ej�2,ej1.p
CITY OF TWAFM
COMMUNITY DEVELOPMENT DEPARTMENT 0REG ON
13125 S.W.Hall Blvd..P 0 Box 23397 1 igard.Oregon 97223.1503)6394175 DA1,1:.,. J:SS I K%1) :1. 2 88
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This permit is issued subject to the regulations contained In Title 14 NO 101 "777
of the TIVIC. State of Oregon Specialty Codes.zoning regulations ........................... •-••.•••••......•-•- ....
and all other applicable codes and ordinances. and It is hereby VIFECA01PIED 1:NSiPr:.C.;T:l.ONS
agreed that the work will be done In accordance with the plans and GAS
specifications and in compliance with all applicable codes slid
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city POUGH--.1 N
business tax permits. This permit will expire and become null and r: T NAL
void It work is not started within 180 days,or If work is Suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to assure
all required inspections are reqdested and approved
Permittee Signature
Issued By
(..'.oL L. 1-:11D J:W;PE:A.'1'TA'ON 639-4411.1,1`5
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A1304,`-:
uI I Y UI- I IUAHU MECHANICAL PERMIT -
Pornul 2 c-f I Z---
����/�/ Description
Table 3A Mechanical Cod* CITY PRICE AMT
City of Tigard
13125 S.W. Hall Blvd. " 1 ,{� 15 "` 14� 1) Permit Fee - - - —_-- —0- -0- 10.00
— —
P.O. Box 23397
Tigard, OR 97223 2) Supplemental Permit 3.00
/ � ._---------- —
639-4175 1) Furnace to 100,000 BTU
incl.ducts R vents 6.00
2) Furnace 100,000 BTU l 7.50
incl.ducts 6 vents
Name of Devektpment - 3) Floor Furnace &00
incl.vent
Job A •e4) Suspended heater,wall heater 6.00Address 7 4 t S S W U ice...; 1i or floor mounted heater �_ T
Tart La �_- _—. Map Nn5) Vent not incl.in J.00
Lo Block Subdivision appliance permit
Na"(o,name M business) 6) Repair of heating,►efr iq., 6.00
101.bet i �tt� L.?ft-b��„ ,.- cooling,absorption unit
Maitntg^ddr& ptw" 7) Boiler or comp to 3 HP 600
Owner absorp.unit to 100,000 BTU
Cilvrst le 7,p 8) Boiler or comp to 3 HP- 15 H P 11.00 _
absorp.unit to 500,000 BTU
Name� ) 1'Boiler or comp 15-30 HP r
9 .00
an h)rp.unit' -1 million
10
) Boiler or comp to 30-5C HP 22.50
Ma tir,gftddresR x ) r b 9 Pt>ate absorp.unit 1 -1.75 million
two
�� �• — Boiler or comp to 50 HP
City/SI Is ll / Zip
�i vrt-)•.�1 � D� x'121 '3 1 t) absorp.unit 1,750,000 BTU ^.` 31.50
State Registration No City Bus.Ta+No t 2) Air handling
unit to
1/�/ hr�r•, 10,000 CFM
I hereby acknowledge that I have read 's aroo,alion that the informatkxt given is 13) Air handling unit 7.50
10,000 GFM +
coned,that I arts the owner or auittonxed agont of the owner,that plans submitted are in — --
compliance with State taws,that I am registered with the State Builders'Board,that the t 4) Non portable 450
number given is cowtoct (tl eMempf flan State registration please give reason below) evapor3le Cooler
Vent fan connected
15 3.00
to a sing)t duct
16) Ventilation system not 4.50
included in appliance permit _
— - ---- _ 17) Hood served by — 4.50 _ —
mechanical exhaust
Signature(owner or agent) ^ 1 Dale1 B) Domestic type 7.50
Describe work [a addition n alteration O repair ❑ incinerator
to be done residential_ non-residential ❑ 1 g) Commercial or industrial 30.00
type incinerator
Existing use of — -- --- --- --
building properly e� Other i.e.,woodstove,wa!er
9 or p P Y j..._._._ .�_ 20) heater,solar,clothes dryers,etc. 4.50
Pronosed use of — - -
building or properly.,-.,.,-,--,,,,_� 21) Gas piping one to lour outlets 2.00
Type of duel- oil ( I natural gas C] LPG Cl electric Ll
22) More than 4-per outlet
NOTICE --- -� -- 5118-TOTAL % y r�
T...S PERMIT BECOMES NULL AND VOID IF WORK OR CON. "� -"
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S�fp 4@6 SURCHARGE -73
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25'.OF SL113-TOTAL
ABANDONED FOR H PERIOD OF 180 DAYS AT ANY TIME AFTER �--`- --
-
WORK IS COMMENCED TOTAL— _ _ " Litt
Special Conditions
Il,rlr r:';acct by